双歧杆菌三联活菌胶囊联合四联疗法根除幽门螺杆菌的临床观察

双歧杆菌三联活菌胶囊联合四联疗法根除幽门螺杆菌的临床观察

摘要目的探討双歧杆菌三联活菌胶囊联合四联疗法根除幽门螺杆菌治疗消化性溃疡的疗效及安全性。方法122例合并幽门螺杆菌感染的消化性溃疡患者，随机分为对照组和治疗组，每组61例。对照组采用四联疗法治疗，疗程10 d，治疗组在对照组的基础上加用双歧杆菌三联活菌胶囊口服，疗程10 d。停用四联药物后继续口服奥美拉唑肠溶胶囊，胃溃疡服用6周，十二指肠溃疡服用4周；治疗组继续服用双歧杆菌三联活菌胶囊10 d。最后在内镜下观察两组溃疡的愈合情况。结果治疗组和对照组幽门螺杆菌根除率分别为91.8%、73.8%，疗程结束后复查胃镜溃疡达瘢痕期两组分别为86.9%、67.2%，两组比较差异均有统计学意义（P＜0.01）。两组上腹部不适、便秘发生率比较差异具有统计学意义（P＜0.01或P＜0.05）。结论双歧杆菌三联活菌胶囊联合四联疗法治疗合并幽门螺杆菌感染的消化性溃疡，镜下溃疡愈合情况明显优于单用四联疗法，幽门螺杆菌的根除率明显提高，且能减少应用抗生素的不良反应。

关键词消化性溃疡；幽门螺杆菌；双歧杆菌三联活菌胶囊；四联疗法

Clinical observation of bifidobacterium-triple viable capsule combined with quadruple therapy in eradication of helicobacter pylori YUAN Quan，XU Xiu-fen，LIU Gui-fang. Department of Gastroenterology，Shandong Weihai City Weihaiwei People’s Hospital，264200，China

【Abstract】Objective To investigate curative effect and safety by bifidobacterium-triple viable capsule combined with quadruple therapy in eradication of helicobacter pylori for treating peptic ulcer. Methods A total of 122 patients of helicobacter pylori complicated with peptic ulcer were randomly divided into control group and treatment group，with 61 cases in each group. The control group received quadruple therapy for 10 d，and the treatment group received additional bifidobacterium-triple viable capsule by oral administration for 10 d. After withdrawal of quadruple drugs，omeprazole enteric-coated capsule was given by oral administration for 6 weeks in gastric ulcer and 4 weeks in duodenal ulcer. The treatment group continuously received bifidobacterium-triple viable capsule for 10 d. Healing condition of the two groups was observed by endoscope. Results The treatment group and the control group had eradication rate of helicobacter pylori respectively as 91.8% and 73.8%. After treatment，cicatricial phase of ulcer by gastroscopy accounted for 86.9% and 67.2% respectively in the two groups. Their differences all had statistical significance （P＜0.01）. The difference of incidences of epigastric discomfort and constipation had statistical significance between the two groups （P＜0.01 or P＜0.05）. Conclusion Combination of bifidobacterium-triple viable capsule and quadruple therapy provides better gastroscopic ulcer healing than quadruple therapy alone in the treatment of peptic ulcer complicated with helicobacter pylori. This method can remarkably improve eradication rate of helicobacter pylori and reduce adverse reactions induced by antibiotics.【Key words】Peptic ulcer；

Helicobacter pylori；Bifidobacterium-triple viable capsule；Quadruple therapy

幽门螺杆菌阳性的消化性溃疡患者日益增多，严重影响患者的生活质量。所以目前的治疗是无论在活动期，还是在非活动期均需进行根除治疗，尤其对于有并发症的消化性溃疡患者更应该进行根除治疗。2012年我国消化专业委员会在上海发布《第四次全国幽门螺杆菌感染处理共识报告》[1]。应用四联药物治疗合并幽门螺杆菌感染的消化性溃疡、慢性胃炎、胃癌等消化道疾病成为国内的一种主流。但临床医生在根除幽门螺杆菌治疗过程中发现应用大剂量抗生素时患者出现较多的不良反应。随着人们生活水平的提高，患者对健康要求也相应提高，针对疾病的最佳治疗方案应符合疗效好、疗程短、不良反应少、药物容易获得且费用低为前提。为此作者采用双歧杆菌三联活菌胶囊联合四联疗法用于幽门螺杆菌感染的消化性溃疡患者的初治，通过对比评估该治疗方案的疗效及安全性，为寻找根除幽门螺杆菌最佳治疗方案提供一种新的思路，现报告如下。

1 资料与方法

1. 1 一般资料收集2014年6～12月在本院消化科住院的合并幽门螺杆菌感染的消化性溃疡患者122例，随机分为对照组和治疗组。治疗组61例，男31例，女30例，年龄18～78岁，平均年龄（55.5±6.7）岁。对照组61例，男29例，女32例，年龄20～79岁，平均年龄（54.6±6.8）岁。两组患者年龄、性别及病因构成比较差异无统计学意义（P>0.05），具有可比性。

1. 2 入选标准①有消化道症状，均经胃镜检查证实胃或十二指肠溃疡，镜下表现溃疡直径>1 cm，可单发或多发，溃疡表面有黄白苔，无活动性出血，且为首次发病；②通过13C-尿素呼气试验检测结果呈陽性；③符合2012年国内共识意见推荐的幽门螺杆菌根除适应证；④近4周未用过益生菌、阿莫西林、克拉霉素、铋剂及抑制胃酸分泌的药物；⑤年龄>18岁，从未接受过根除幽门螺杆菌的治疗。

1. 3 排除标准①对本研究所选药物过敏者；②有严重肝、肾功能不全及恶性肿瘤等不能配合完成全程治疗者；③有幽门梗阻、出血等消化性溃疡并发症的患者；④妊娠期或哺乳期妇女。

1. 4 治疗方案对照组采用四联疗法（奥美拉唑肠溶胶囊20 mg/次，2次/d，餐前30 min口服；阿莫西林胶囊1 g/次，2次/d，餐后即刻口服；克拉霉素缓释片0.5 g/次，2次/d，餐后即刻口服；枸橼酸铋钾胶囊220 mg/次，2次/d，餐前30 min口服），疗程10 d。治疗组除服用上述4种药物外，餐后2 h加用双歧杆菌三联活菌胶囊（为粪链球菌、嗜酸乳杆菌、双歧杆菌 3 种肠道固有菌的活菌微生态复方制剂）口服，0.63 g/次，2次/d；疗程10 d。停用四联药物后继续口服奥美拉唑肠溶胶囊，胃溃疡服用6周，十二指肠溃疡服用4周；治疗组继续服用双歧杆菌三联活菌胶囊10 d。完全停用所有药物4周后复查尿素呼气试验，复查胃镜了解溃疡愈合情况。

1. 5 观察指标及疗效判定标准观察各组溃疡愈合情况、根除率及不良反应。